'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Cervicalgia

Nurse practitioners take twice as long to carry out consultations as GPs, research has found.

The study comparing the content of consultations found nurses 'talked significantly more than doctors', particularly about how to apply or carry out treatments. The result was an average 10-minute consultation length, compared with five minutes for GPs.

The report, Comparison of GP and Nurse Practitioner Consultations published in this month's British Journal of General Practice, said there was no economic and health outcome research suggesting nurse practitioners were more clinically effective. But nurses scored higher on patient satisfaction surveys, largely as a result of the extra time they gave to patients.

It concluded: 'To raise satisfaction, but possibly negatively affect the cost balance, GPs might consider adopting some of the behaviours of nurse practitioners.

'Nurse practitioners, on the other hand, may consider the cost savings that might be achieved were they to adopt the (more efficient but apparently less satisfying) GP approach.'

Co-author Professor Clive Seale, professor of sociology at Brunel University, said the fact patients were more satisfied, even though nurses may not be as efficient, should not be ignored.

He said: 'You could argue that the health system is there to make people feel good.'

But Dr Dermot Ryan, a GP in Loughborough, Leicestershire, said the fact patients may feel more satisfied with nurse practitioners was not necessarily positive.

'Nurses often offer reassurance where it is inappropriate ­ you often have to tell patients what they don't want to hear,' he said.

Dr Ryan added: 'Nurse practitioners often order unnecessary tests or X-rays or make unnecessary referrals. They are not a cheap option by any means.'